March, 2016

Emotional Rescue Animals

By Michael J. Katin, MD

I come to you, so silent in the night
So stealthy, so animal quiet
I'll be your savior, steadfast and true
-- Jagger and Richards, 1979

Despite January's announcement of the "moon shot" initiative to cure cancer, there is still a great deal of uncertainty about how support will be given for programs to maximally impact the population as a whole. Multiple surveys have indicated that health is considered one of the most important things in life but for some reason the government wants to keep finding ways to restrain increasing expenditures for medical care. As more proton units are built throughout the country the question is raised as to whether the cost of 1.5 to 2 times as high as high-energy x-ray therapy is justified. Major breakthroughs in systemic therapy, such as immune checkpoint blockers, have come available, causing the cost of keeping alive a person with advanced cancer to come under scrutiny. It is estimated that treating a patient with advanced melanoma with Keytruda for one year would cost $150,000. In a totally unrelated item, it was reported in February that information obtained through the FOIA showed that it cost $206,337.00 per hour for Air Force One to be flown. The Expedia app does not seem to be available to anyone in the White House Travel Office.

This horrendous development of a rising life expectancy, producing more and more old people, and finding ways to keep them going even longer, has produced a crisis in terms of paying for health care. Can a price be put on a human life? Well, of course, it can.

There are multiple ways to look at this. First would be the value assigned to one year of "quality life." There have been many values assigned by various insurance companies, but one standard is taken from the paper by Lee, Chertow, and Zenios in the journal Value in Health (yes, I had no idea there was such a journal) in 2009 which calculated that the value of a statistical year of life, based on end-stage renal disease dialysis data, was $129,090 per
QALY (quality-adjusted life-year) BUT only $61, 294 per year. The reason for the difference is that one QALY unit is a year spent in perfect health, and anything condition otherwise is worth less than one unit (death, apparently being a low-quality condition, is counted as zero). In the United States Military, anyone dying while on active duty (and certain other categories) has $100,000 as a "death gratuity " (nice terminology) paid to his or her survivors in addition to a $400,000 life insurance policy. Apparently the FDA and EPA are more generous, valuing the price of a human life at r$7.9 million and $9.1 million, espectively. Either people are worth more now or estimates have been seriously wrong one way or the other, since if a person was killed in a Ford Pinto in the 1970s, the value of that life was only $200,000.

The point being, health care is the most important thing for which we should be spending our resources. Rather than this irrational attempt to keep cutting back on providing citizens with the maximum support for their health needs we should be looking for what else should be covered by Medicare, Medicaid, CHIP, and all the other agencies and for which private insurers should be made responsible as well.

Why isn't dental care covered? Are we not told all the time that gingivitis can lead to atherosclerosis and heart disease? Not to mention that poor dentition is associated with poor self-image and probably holds back many people from their full potential. How can we continue to live in a society that does not recognize the importance of making regular cleaning, orthodontia, and veneers available to even the most disadvantaged of us?

We should question as to why there isn't coverage for branches of medicine such as apitherapy and crystal therapy. Even more amazingly, faith healing, which has been around for millennia, is not considered worthy of being on the fee schedule. This could include practitioners of psychic surgery and miraculous healers such as Francis MacNutt, and including even the Pope himself (but only if he were enrolled with CMS). Unfortunately, if evidence-based medical criteria are unreasonably requested, there could be pushback since a randomized study reported in the American Heart Journal by Herbert Benson of the Mind/Body Medical Institute, and co-authors described no benefit in intercessory prayer (ICP?) in complication-free recovery from coronary artery bypass graft surgery in patients in six cardiac surgery institutions, and, in fact, the group that knew that prayer was being offered had a higher complication rate. The atheistic press had a field day with this, but the appropriate comment was made by Harold Koenig of the Center for Spirituality, Theology, and Health at Duke University, who observed that God would be concerned about a person's eternal salvation and "why would God change His plans for a particular person just because they're in a research study?" Harold Koenig is a Professor of Psychiatry and Behavioral Sciences and Associate Professor of Medicine and apparently not a board-certified grammarian.

The list could go on for another five columns but I think all would agree the most justified expenditure to be proposed in the medical field would be for service animals and comfort animals. Everyone recognizes the huge contribution of service animals to allow those persons with impairments to function more normally in society. Although "service animals" usually conveys the idea of seeing-eye dogs, there are other species contributing. Miniature horses are more commonly being trained as guide animals for vision-impaired persons, and there are also dogs that can sense impending seizures. Pigs can be trained as guide pigs as well as helper pigs and emotional support pigs and, as of July 5, 2012, were approved by the Department of Transportation to be allowed on airplanes in those capacities. Helper monkeys are trained to assist persons with movement restriction. Are they paid by insurances? Check out the Social Security Disability Help page ---no mention of coverage. Heaven forbid that therapy and comfort animals should be included in insurance benefits despite all the good they perform.

Fortunately, the Americans with Disabilities Act and other legislation, such as the Air Carrier Access Act, allow persons with service animals to function as normally as possible. The role for therapy animals is somewhat more restricted, unfortunately. The Air Carrier Access Act will not allow therapy snakes, ferrets, rodents, and spiders, indicating that progress will still need to be made to bring the airlines into the 21st century.

Regardless of one's political persuasion, it seems reasonable that these and other medical expenses should be at least shared by our government agencies in order to bring optimal quality of life to our citizens. Also regardless of one's feeling about proton beam therapy, crystal therapy, and pyorrhea, it is obvious that the first priority should be to help the most downtrodden and least empowered persons in this country by providing full coverage for comfort animals.

For radiation oncologists.

Emanuel Countdown: The Emanuel Countdown will be suspended for several months, to be replaced by a tribute to each of the 7 persons currently seeking the position of President of the United States. The Emanuel Countdown will resume after the nominees of both parties have been selected. The clock, however, will still be running.

Once before he ran for President and that fell flat
Then he worked for Lehman Brothers (but we'll forget about that)
He got back into politics and this time did great
He was twice elected Governor of the Buckeye State.